Every year, millions of American workers get injured on the job. Most of these workers file workers’ compensation claims seeking benefits to pay for their medical care, time lost at work, and other injury-related costs. State government agencies that oversee workers’ compensation insurance programs try to make filing a claim seem easy and accommodating of workers’ needs. Those efforts are misleading.
In many states, including Nevada, the process of applying for and obtaining workers’ compensation benefits comes riddled with traps for unwary workers, all designed to reduce or foreclose their rights to benefits.
To avoid falling into these traps, injured workers should retain an experienced workers’ compensation attorney to help them file a claim or to appeal a claim denial. Here is how a workers’ comp lawyer can help you.
Workers’ Compensation Claims
Workers’ compensation insurance is mandatory insurance your employer carries to protect you against injuries you sustain while on the job. Most people think of workers’ comp claims as limited to heavy labor jobs, such as working in construction. However, although laborers do account for nearly 8 percent of all workers’ compensation claimants, even office workers and others who work in non-physically-demanding jobs can get injured and need workers’ comp benefits.
When a Nevada worker sustains any kind of injury on the job, workers’ compensation entitles the worker to some or all of the following benefits, depending upon the nature and severity of the injury:
- The cost of medical treatment;
- Lost time compensation – Temporary Total Disability/Temporary Partial Disability (TTD/TPD);
- Permanent Partial Disability (PPD);
- Permanent Total Disability (PTD);
- Vocational Rehabilitation;
- Dependent’s payments in the event of death; and
- Other claims-related benefits or expenses (i.e., mileage reimbursement).
It seems simple enough – you get injured on the job, you file a claim, and you receive benefits. Do not be deceived. In 2019, for example, over 12,000 workers’ compensation claims were filed in Nevada. As of January 5, 2020, however, fewer than 5,000 of those claims were paid.
Obtaining workers’ comp benefits in Nevada is anything but a sure thing. In fact, it can be downright difficult, as the statistics bear out.
Insurers Frequently Deny Claims
Workers’ compensation insurance is still insurance. Yes, it is state-mandated. Yes, it is heavily regulated. But at the end of the day, it is a form of insurance issued by an insurance company that exists to make money, paid for by an employer that wants to keep its insurance costs as low as possible. Combine those two factors and what do you get? A strong incentive for workers’ compensation insurance carriers to deny claims and for employers (and business-friendly politicians) to make it less-than-simple to obtain benefits.
You might think your workers’ compensation claim is an open and shut case. You are probably right. Unfortunately, that will not prevent a workers’ comp insurance carrier from trying to find any reason—no matter how trivial or unfair it might seem—to deny your claim, such as:
- Your injury did not happen at work or in connection with your work responsibilities;
- Your claim lacked sufficient medical documentation;
- Your injury is really just a pre-existing condition; or
- You are not as badly hurt as you claim.
If the bullet points above sound like accusations that someone is committing insurance fraud, that’s because they are. Workers’ compensation insurers do not want to pay claims. Their default mindset is that every injured worker is faking or exaggerating an injury. They will make any argument they can to prove that assumption, even if it has no basis in fact.
How a Lawyer Helps You Obtain Benefits
The best way to avoid or fight back against a claim denial is to hire an experienced Nevada workers’ compensation attorney to help you obtain your benefits. Here’s how.
- Claim filing. Do not be fooled into thinking that filing a workers’ comp claim for your job-related injury is straightforward. It might seem like a piece of cake to file a claim, but if you fail to provide the necessary information, or provide the wrong kind of information (or miss a deadline, or see the wrong doctor, and so on), then you will end up with a claim denial on your hands. Lawyers can help you craft a claim that has a high chance of being approved right off the bat for maximum benefits and, just as importantly, that avoids the traps in the process that could doom your claim for all time.
- Administrative appeals. Lawyers represent workers in appealing claim denials to the Nevada Department of Administration (DOA). Although workers do not technically have to have a lawyer represent them in the two stages of appeals that happen at the DOA, they risk losing significant rights if they try to do without legal representation.
- Lawsuits. If appealing a claim denial to the DOA does not succeed, lawyers can also represent workers in lawsuits in Nevada civil court seeking to overturn the DOA’s decision.
Along the way, lawyers play a critical role in advising injured workers on how to avoid slip-ups that can sink their benefits claims. Workers frequently do not realize how they put themselves under a microscope when they file a claim, and risk having their rights curtailed if, for example, they post to social media in a manner that makes them look healthier than they really are. Do not risk making mistakes. Hire a lawyer instead.
How a Lawyer Protects You From Retaliation
You have the right in Nevada to file a workers’ compensation claim if you get injured on the job. It is illegal for your employer to retaliate, such as by firing or demoting you, in reaction to you filing a workers’ comp claim.
Unfortunately, that does not mean employers always follow the rules.
If your employer has taken “adverse” employment action against you because you filed a workers’ comp claim, an experienced workers’ compensation lawyer can advise you on your rights to take legal action for damages.
Workers’ Compensation Lawyers Fight for You.
Hurt on the job? An experienced workers’ compensation attorney can tell you how you can obtain the benefits you deserve.
Benson & Bingham
626 S 10th St
Las Vegas, NV 89101